The complexity and controversy of fat soluble vitamins absorption
Fat soluble vitamins include D3, Vitamin A, Vitamin E, Vitamin K and a form of vitamin C called Ascorbyl Palmitate. It is common knowledge that fat soluble vitamins absorb better when eaten with a meal that contains fat. The controversy is do these vitamins compete with one another for that fat to be able to be absorbed and does that warrant the need to separate each fat soluble vitamin from one another to do so? We have theories and then we have research. What do we follow and how does it pertain to us an individual’s?
1. D3 is a hormone that is found to be deficient in persons who have one or more autoimmune diseases, as well as people with heart disease and type 2 diabetes.
“It turns out that vitamin D is best absorbed with a low-to-moderate amount of fat, compared to no fat or lots of fat. Specifically, researchers have showed that 11 grams of fat leads to higher absorption than either 35 grams or 0 grams, at 16% higher and 20% higher respectively”
Meal conditions affect the absorption of supplemental vitamin D3 but not the plasma 25-hydroxyvitamin D response to supplementation https://www.ncbi.nlm.nih.gov/pubmed/23427007
“We conclude that absorption was increased when a 50,000 IU dose of vitamin D was taken with a low-fat meal, compared with a high-fat meal and no meal, but that the greater absorption did not result in higher plasma 25(OH)D levels in the low-fat meal group.”
It was found that 11 grams of fat/99 calories were suitable for proper absorption of D3.The question is why wouldn’t the plasma 25(OH) D levels be higher with better absorption? https://www.ncbi.nlm.nih.gov/pmc/ar...
Ingested and cutaneously produced vitamin D is rapidly converted to 25(OH)D, but in serum only a fraction of 25(OH)D is converted to its active metabolite 1,25(OH)2D. Thus, measurement of the total 25(OH)D level is the best test to assess body stores of vitamin D. The total 25(OH)D level allows for the diagnosis and monitoring of vitamin D deficiency, whereas quantification of 25(OH)D2 and 25(OH)D3 fractions may facilitate treatment monitoring. For example, in patients without clinical improvement after D2 or D3 supplementation, lack of increase in the corresponding 25(OH)D2 or 25(OH)D3 and total 25(OH) D levels may indicate inadequate dosing, nonadherence, or malabsorption. Some laboratory assays for vitamin D cannot differentiate between 25(OH)D2 and 25(OH)D3 and will only report a total 25(OH)D level. Some laboratory assays under detect D2 metabolites, which may give the appearance of ineffective D2 supplementation.
2. Vitamin A has also been linked to autoimmune diseases and is suggested to be added to our dietary supplementation in lowering the pro-inflammatory response
Fat-soluble vitamin intestinal absorption: absorption sites in the intestine and interactions for absorption. https://www.ncbi.nlm.nih.gov/pubmed/25442537
“Vitamin A also significantly decreased the uptake of the other FSVs (fat soluble vitamins) but, conversely, its uptake was not impaired by vitamins D and K and even promoted by vitamin E.” This abstract may be confusing but simply put, Vitamin E can enhance the absorption of Vitamin A, while Vitamins A will hamper vitamins D and K ability to absorb. Vitamin D and K should not be taken with Vitamin A.3.
Vitamin E is suggested in low doses (200-400 IUS) and mainly to assist the absorption of selenium and both aid in the metabolism of T3 hormone. Higher doses have been associated with the risk of vitamin K deficiency. Lower doses have been found to enhance the absorption of vitamin A.
Complexity of vitamin E metabolism. https://www.ncbi.nlm.nih.gov/pubmed/26981194
“Most of the metabolic reactions and processes that are involved with vitamin E are also shared by other fat soluble vitamins. Influencing interactions with other nutrients such as vitamin K or pharmaceuticals are also covered by this review.”(s)
Interaction with vitamin K metabolism https://www.wjgnet.com/1949-8454/full/v7/i1/14.htm
“The interference of vitamin E with vitamin K metabolism and, as a result, with blood coagulation has been known for decades . As shown by several supplementation studies with vitamin E in rats  or humans  an increased risk of bleeding was noted. The underlying molecular mechanisms are still unclear, but recent research has shed new light on this aspect of vitamin E metabolism. Vitamin E and vitamin K share the same metabolic pathways, as the degradation of both vitamins is initiated with a ω-hydroxylation followed by subsequent β-oxidation of the aliphatic side-chain, thus resulting in urinary and biliary excretion of the respective carboxylic acids or conjugates with shortened side-chains .
When vitamin E increases the expression or activity of enzymes involved in its own degradation, it is possible that vitamin K metabolism is also enhanced under elevated vitamin E status; this may lead to higher rates of vitamin K excretion and in turn to vitamin K deficiency with enhanced bleeding risk
The authors observed a downregulation of the expression of CYP enzymes CYP3A, CYP4F4 and CYP4F1, which was explained by an alternative mode of interference of vitamin E with vitamin K metabolism apart from the induced degradation of vitamin K. The induction of the xenobiotic exporters ABCB1/MDR1 and ABCG2/BCRP1 provided the first hints for an increased excretion of vitamin K metabolites into bile. This concept is supported by the 100-fold increased urinary excretion of α-CEHC in response to the application of α-TOH, whereas urinary excretion of vitamin K metabolites remained unchanged.”Vitamin E has shown to degrade vitamin K and increases it’s elimination in bile. Vitamin E should be taken at entirely different time of that day than Vitamin K.
4. Vitamin K1 (MK-4) and Vitamin K2 (MK-7) has emerged as a super vitamin in the prevention of osteoporosis and lowering cholesterol and reducing calcium /plaque on the arteries.Vitamin K was found to require the most amount of fat for best absorption. In addition, a given dose of vitamin K2 will not be fully absorbed and in most cases only half the dose taken will be assimilated. The good news is that only 32 mcg is actually need to achieve the desired effects for bone and heart protection. If one takes a dose of 100 mcg of K2 and only 50% gets absorbed that would be enough. The amount of fat that would need to be consumed to do this is 35 grams of fat/ 315 calories in one meal.
That is more than most women would eat in one meal. When taking D3 along with your K2 this must be taking into consideration. It is not that D3 competes or interferes in the absorption process of K2, it is that K2 requires a high amount of fat in order to absorb that 50% of the total dose taken. Effect of dietary fat content on oral bioavailability of menatetrenone (K1) in humans. https://www.ncbi.nlm.nih.gov/pubmed/8877895
“The oral bioavailability of lipid-soluble vitamin K was influenced by the fat content of a meal, although the increase in bioavailability seemed to reach a peak when the lipid content of the meal was > 35 g.” Please note K2 (MK-7 breaks down to K1 /MK-4)Since we know that a lower fat meal or lower fat content is suitable for proper absorption of D3, 11 grams/99 calories according to the research, one would need to eat a total fat content of 414 calories to be able to take and absorb both vitamins at the same time. What is also widely research are the synergistic effects of combining the K2 and D3 together for osteoporosis and cardiovascular disease relating to plaque and calcium within the heart and arteries and the absorption of D3 and calcium into the bones.Taking both of these supplements together or closely are very important! Below are significant studies showing the synergistic power of both.
[Efficacy of combined administration of vitamin D3 and vitamin K2 for primary osteoporosis]. https://www.ncbi.nlm.nih.gov/pubmed/15775388
Therapeutic effects of systemic vitamin k2 and vitamin d3 on gingival inflammation and alveolar bone in rats with experimentally induced periodontitis https://www.ncbi.nlm.nih.gov/pubmed/25569194
In vitro vitamin K (2) and 1α, 25-dihydroxyvitamin D (3) combination enhances osteoblasts anabolism of diabetic mice. https://www.ncbi.nlm.nih.gov/pubmed/26452518
Vitamins D3 and K2 may partially counterbalance the detrimental effects of pentosidine in ex vivo human osteoblasts. https://www.ncbi.nlm.nih.gov/pubmed/27655488
Combined treatment of leukemia cells with vitamin K2 and 1alpha, 25-dihydroxyvitamin D3 enhances monocytic differentiation along with becoming resistant to apoptosis by induction of cytoplasmic p21CIP1. https://www.ncbi.nlm.nih.gov/pubmed/16142303
Melatonin-micronutrients Osteopenia Treatment Study (MOTS): a translational study assessing melatonin, strontium (citrate), vitamin D3 and vitamin K2 (MK7) on bone density, bone marker turnover and health related quality of life in postmenopausal osteopenic women following a one-year double-blind RCT and on osteoblast-osteoclast co-cultures. https://www.ncbi.nlm.nih.gov/pubmed/28130552
How do supplement with vitamin K2 and D3 and get the most of the powerful synergistic duo?Let’s look at all the things to consider;· We need 35g of fat to absorb K2· We need 11g of fat to absorb D3· Taken together will not interfere with absorption of one another as long as there is enough fat. 35 grams of fat or 315 calories from fat for K2 and 11 grams of fat or 99 calories of fat for D3. The total of 46 grams of fat/ 414 calories to absorb both at the same time. · It is best to take both D3 and K2 vitamins at different times of the day than vitamin A & E. Vitamin A will compete with D and K . Vitamin E can increase the elimination of Vitamin K (i.e urine and bile) and cause K2 deficiency. Vitamin E ,in a low dose will enhance the absorption of vitamin A. D3 and K2 can be taken together or close together and vitamin A and E ( in low dose) can be taken together or close together. 1) Increasing the ability to absorb fat-soluble vitamins, CoQ10 and Boswellia are emerging as possible vehicles to help this issue. More research needs to be done.
Novel HPLC-UV Method for Simultaneous Determination of Fat-soluble Vitamins and Coenzyme Q10 in Medicines and Supplements. https://www.ncbi.nlm.nih.gov/pubmed/28862306
Investigating permeability related hurdles in oral delivery of 11-keto-β-boswellic acid. https://www.ncbi.nlm.nih.gov/pubmed/?term=Boswellia+and+D3
2) Take the K2 supplement with dinner and add an omega 3 fish oil to increase fat intake3) Take the D3 at bedtime or a few hours after dinner with a tablespoon of nut butter. Suggestions on how to take fat soluble vitamins so they do not compete with one another so you may get the most of your supplementation.
1) Take Vitamin A in the morning with breakfast. Vitamin E in a low dose can be taken as well.
2) If you are taking the myo inositol, selenium and low dose E, first thing in the morning on an empty stomach then you do not need to take more E when you take vitamin A at breakfast.
3) Take Vitamin K2 with Lunch or Dinner whichever is your fattiest meal (35 grams of fat), but also try to take the D3 closely after to reap the benefits of its synergistic power. Take the D3 with at least 11g of fat/99 calories, more fat will not help absorb D3 better and do not forget your magnesium with the D3.
4) Consider that Magnesium is best to be taken along with D3, but magnesium can make some sleepy. If this is the case, take your D3 at bedtime along with the magnesium. If you do not want to eat anything at bedtime (11g of fat) consider an Omega 3 fish oil and /or 100mg of CoQ10. Timing solutions;
Malabsorption is the inability of the intestines to absorb nutrients. In IBD, this occurs as a result of bleeding and diarrhea, as a side effect from some of the medications, and as a result of surgery. Malnutrition may occur in ulcerative colitis, but it tends to be less severe than with Crohn's disease.
Irritable Bowel Syndrome (IBS) is a condition that may be marked by abdominal pain, bloating, fullness, indigestion, belching, constipation and/or diarrhea. IBS symptoms can result from malabsorption of fructose. ... A low-fructose diet has been found to improve IBS symptoms in some patients.